The Balancing Act of a Working Woman in Medicine

Curiously, at some point in their lives, all working women are asked the question, “How do you balance work and family?”  However, what defines balance? Is it being in perfect harmony at all moments in time?

Balancing work and family life is an age-old working woman’s dilemma.  In reality though, there is never a complete balance.  Instead, it is simply a dance of shifting priorities of different aspects of your life at any given moment.  There is no horizontal balance, but rather a constant adjustment of which life aspect is higher and which plummets to the ground.

Life in medicine is already a unique situation. As medical students, we put in long hours memorizing endless facts, dissecting our cadavers to perfection, and rounding at 4am. At times, medical students are found in the wee hours of the night making up stories with their cadavers, whom they often share more mealtimes than with their friends. As we move on to residency, the hours in the hospital increase to extreme amounts.  The standard work week in most industries is 40 hours, and yet as residents we often work 80-100 hours a week with no concept of overtime. In 2003, after prominent legal cases of resident fatigue leading to patient deaths highlighted the effects of sleep deprivation on brain function, the federal government imposed an 80-hour workweek limit.  Subsequently, senior attendings balked at this restriction of hours and often residents would self-report fewer hours than actually worked, so as not to be labeled “weak” or “slackers”.

In residency, there is no concept of balance; it’s survival mode. You hoard food when you have time; you sleep for a few hours and then start the cycle again.  As a resident, I often found myself nodding off at traffic lights and even figured out where I could catch a minute or two of sleep during my commute. As ludicrous as it sounds, this was the reality for many other residents as well. We had mastered sleeping with our eyes open for lectures, so catnaps at traffic lights was no giant leap. One night, after I traded night shifts with my colleague, my attending asked me why I did so. I replied that I would like to have dinner at home with my husband at least one evening since it was our anniversary.  He chuckled and stated that we must be newlyweds to still consider meals together important.  In fact, my husband and I were actually several years into our marriage. The irony is that as physicians, we preach to our patients about healthy habits, including daily exercise, time for hobbies, forming relationships, and getting a good night’s sleep, all of which are  unthinkable to us in those years of residency.

As a working mother, it can get even more difficult.  While, there is no perfect time to have a child, the median age of childbirth occurs during the time most women are in residency.  Many of our prime reproductive years  are spent working 80-hour weeks and we are not only supposed to produce healthy babies, but also expected to be available to take care of them, as the “June Cleaver mom”.   The physical and emotional stress on residents does take its toll. In my own small residency program containing five female residents, three suffered miscarriages in a single year.  We continue to be unabashedly reminded of the ticking female biological clock by those around us.

A close friend of mine grew up in an ambitious family of physicians where it was expected that all of the children go to medical school and ultimately, take over the family medical business.  My friend therefore completed the necessities of medical school and graduate training, working various jobs until her fourth child was found to have severe neurological disabilities shortly after birth. After receiving pressure to return to work and get back into her field, she stated to me that she realized that anyone can be a great doctor, but not just anyone can be a great mother to her kids.

Of course we would expect a mother to step back and take care of a disabled child, but would the world exalt her if she decided to get a full-time nanny to care for the child and instead pursue the neurosurgical career that she had invested so many years of training in?

The bottom line is that in balancing your life, there is no set standard. Everyone’s priorities in life are different and holding yourself to someone else’s standards can be crippling. What does being a successful physician mean? Is it working six days a week, being available by phone 24/7, and cutting a family vacation short to care for a patient? Does the empathy for a patient surpass the empathy given to one’s child?  Is a female physician who chooses a part-time position to be more available for her own children or her hobbies less of a doctor? The greatest sacrifice physicians’ make is that they are forced to give more to their patients than to their families.

Surprisingly, this balancing act is usually delegated to working mothers and rarely to fathers. Is it expected that fathers who are physicians should never think about working part-time or wanting to be home or with their children?

My advice when figuring out your own balancing act in medicine is as follows:

1. Realize that life is in stages. At any given time, one dimension may require a larger investment in time and energy. Keep in mind that this too will pass and your investment will need to shift to something else.

2. Let go of societal expectations. Have a firm understanding with your family and/or spouse of your responsibilities, goals and what makes you happy.

3. Find time for yourself.   Working women need to allot time for ourselves in the midst of time given to others (which includes children for working mothers).  Recharge with a weekend away with friends. Travel without the kids to an adventurous destination, or just set aside one hour twice a week to read a book and slowly sip your coffee.  Make time for whatever relaxes you, which will then give you a renewed outlook and recharge you to tackle the other issues that plague your daily life.

4. Realize that not everyone will agree with your choices.  In my opinion, among the most unsupportive are other working mothers, who harbor the same guilt issues and wish they could make your same choices if you are able to juggle things well.






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